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| Plan | Bronze 60 HDHP 7000/0 (shop) | Trio Silver 70 HMO 2250/55 w Child Dental (shop) | Bronze 60 HMO 5400/60 (shop) | Bronze 60 HMO 6300/65 (shop) | Silver 70 HMO 2600/55 (shop) | Trio Gold 80 HMO 250/35 w Child Dental (shop) | Silver 70 HMO 2100/55 (shop) | Silver 70 HMO 2250/55 (shop) | Silver 70 HMO 1650/55 (shop) | Bronze 60 PPO 6300/65 + Child Dental (shop) | Bronze 60 HDHP PPO 7000/0% + Child Dental (shop) | Trio Platinum 90 HMO 0/20 w Child Dental (shop) | Bronze 60 PPO 6300/65 w Child Dental (shop) | Silver 70 Value PPO 1700/50 + Child Dental Alt (shop) | Silver 70 HDHP PPO 1400/40% + Child Dental Alt (shop) | Silver 70 PPO 2250/50 + Child Dental (shop) | Gold 80 HMO 0/30 (shop) | Gold 80 Value PPO 750/15 + Child Dental Alt (shop) | Silver 70 PPO 2250/50 w Child Dental (shop) | Platinum 90 HMO 0/20 (shop) | Platinum 90 HMO 0/10 (shop) | Gold 80 PPO 0/30 + Child Dental Alt (shop) | Gold 80 PPO 350/25 w Child Dental (shop) | Gold 80 PPO 350/25 + Child Dental (shop) | Platinum 90 PPO 0/15 w Child Dental (shop) | Platinum 90 PPO 0/15 + Child Dental (shop) |
| Metal | Bronze | Silver | Bronze | Bronze | Silver | Gold | Silver | Silver | Silver | Bronze | Bronze | Platinum | Bronze | Silver | Silver | Silver | Gold | Gold | Silver | Platinum | Platinum | Gold | Gold | Gold | Platinum | Platinum |
| Network | Kaiser Permanente | Trio ACO Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Trio ACO Network | Kaiser Permanente | Kaiser Permanente | Kaiser Permanente | Full Network HMO | Full Network HMO | Trio ACO Network | Full PPO Network | Full Network HMO | Full Network HMO | Full Network HMO | Kaiser Permanente | Full Network HMO | Full PPO Network | Kaiser Permanente | Kaiser Permanente | Full Network HMO | Full PPO Network | Full Network HMO | Full PPO Network | Full Network HMO |
| Deductible | $7000/$14,000 family | $2250/$4500 family | $5400/$10,800 family | $6300/$12,600 family | $2600/$5200 family | $250/$500 family | $2100/$4200 family | $2250/$4500 family | $1650/$3300 family | $6300/$12,600 famly | $7000/$14,000 family | None | $6300/$12,600 family | $1700/$3400 family | $1400/$2800 family | $2250/$4500 family | None | $750/$1500 family | $2250/$4500 family | None | None | None | $350/$700 family | $350/$700 family | None | $250/$500 family |
| Coinsurance | 100% coverage for most services | 80% coverage for most services | 50% coverage for most services | 60% coverage for most services | 55% coverage for most services | Fixed copays for most services | 55% coverage for most services | 70% coverage for most services | 60% coverage for most services | 60% coverage for most services | 100% coverage for most services | Fixed copays for most services | 60% coverage for most services | 60% coverage for most services | 60% coverage for most services | 70% coverage for most services | Fixed copays for most services | 70% coverage for most services | 70% coverage for most services | Fixed copays for most services | Fixed copays for most services | 70% coverage for most services | 80% coverage for most services | 80% coverage for most services | 90% coverage for most services | 90% coverage for most services |
| Out of Pocket Mzx | $7000/$14,000 family | $8200/$16,400 family | $8200/16,400 family | $8200/16,400 family | $8200/16,400 family | $7800/$15,600 family | $8200/16,400 family | $8200/16,400 family | $8200/16,400 family | $8200/$16,400 family | $7000/$14,000 family | $4500/9000 family | $8200/$16,400 family | $8000/$16,000 family | $7000/$14,000 family | $8200/$16,400 family | $7000/14,000 family | $7800/$15,600 family | $8200/$16,400 family | $4500/$9000 family | $3000/$6000 family | $7600/$15,200 family | $7800/$15,600 family | $7800/$15,600 family | $4500/9000 family | $3800/$7600 family |
| Ambulance | 100% coverage (after deductible) | 70% coverage (after ded) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | $250 copayment | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) | 60% coverage (ded applies) | 100% coverage (ded applies) | $150 copayment | 60% coverage (after deductible) | 60% coverage (ded applies) | 60% coverage (ded applies) | 70% coverage (ded applies) | $250 copayment (after ded) | $250 copayment (ded applies) | 70% coverage (after deductible) | $150 copayment | $150 copayment | 70% coverage | 80% coverage | 80% coverage (ded waived) | $150 copayment | 90% coverage (ded applies) |
| Chiropractor | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Not covered | Optional | Optional | Not covered | Not covered | Optional | Optional | Optional | Not covered | Optional | Not covered | Not covered | Not covered | Optional | Not covered | Optional | Not covered | Optional |
| Durable Med Equip | 100% coverage (after deductible) | 70% coverage (ded waived) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage | 80% coverage | 55% coverage | 70% coverage | 60% coverage (after ded) | 60% coverage (ded applies) | 100% coverage (ded applies) | 90% coverage | 60% coverage (after deductible) | 60% coverage (ded applies) | 60% coverage (ded applies) | 70% coverage (ded applies) | 80% coverage (after ded) | 70% coverage (ded applies) | 70% coverage (after deductible) | 90% coverage | 90% coverage | 70% coverage | 80% coverage | 80% coverage (ded waived) | 90% coverage | 90% coverage (ded applies) |
| Emergency Room | 100% coverage (after deductible) | 70% coverage (after ded) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | $250 copayment | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) | 60% coverage (ded applies) | 100% coverage (ded applies) | $150 copayment | 60% coverage (after deductible) | 60% coverage (ded applies) | 60% coverage (ded applies) | 70% coverage (ded applies) | $250 copayment (after ded) | $250 copayment (ded applies) | 70% coverage (after deductible) | $150 copay | $200 copay | 70% coverage | $250 copayment | 80% coverage (ded waived) | $200 copayment | 90% coverage (ded applies) |
| Hospital | 100% coverage (after deductible) | 70% coverage (after ded) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | $600 per day 1st 5 days | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) | 60% coverage (ded applies) | 100% coverage (ded applies) | $250 per day 1st 5 days | 60% coverage (after deductible) | 60% coverage (ded applies) | 60% coverage (ded applies) | 70% coverage (ded applies) | $600 per day 1st 5 days | 70% coverage (ded applies) | 70% coverage (after deductible) | $250 per day 1st 5 days | $500 per admission | 70% coverage | 80% coverage (after deductible) | 80% coverage (ded applies) | 90% coverage | 90% coverage (ded applies) |
| Infertility | Optional | Not covered | Optional | Optional | Optional | Not covered | Optional | Optional | Optional | Optional | Optional | Not covered | Not covered | Optional | Optional | Optional | Optional | Optional | Not covered | Optional | Optional | Optional | Not covered | Optional | Not covered | Optional |
| Lab & X-Ray | 100% coverage (after deductible) | $55 lab/$90 X-ray | 50% coverage (after ded) | Lab $40/X-ray 60% coverage (after ded) | $30 lab/$75 X-ray | $35 lab/$55 X-ray | $30 lab/$75 X-ray | $55 lab/$90 X-ray | $30 lab/$75 X-ray after ded | Lab: $40 copay (ded waived)/X-ray $60% cov (ded applies) | 100% coverage (ded applies) | Lab $20 copay / X-ray $30 copay | $40 lab/X-ray 60% after ded | Lab: $40 copay (ded applies)/X-ray $50 copay(ded applies) | Lab: 60% coverage (ded applies)/X-ray 60% cov (ded applies) | Lab: $50 copay (ded waived)/X-ray $85 copay (ded waived) | $30 lab/$40 X-ray | Lab: $25 copay (ded waived)/X-ray $25 copay (ded waived) | $50 lab/$85 X-ray | $20 lab/$30 X-ray | $20 lab/$40 X-ray | Lab: $30 copay/X-ray $40 copay | $25 lab/$65 X-ray | Lab: $25 copay (ded waived)/X-ray $65 copay (ded waived) | Lab $15 copay / X-ray $30 copay | Lab: $30 copay (ded waived)/X-ray $30 copay (ded waived) |
| Office Visit | 100% coverage (after deductible) | $55 copayment | $60 copay first 3 visits then deductible applies | $65 copayment first 3 visits then deductible applies | $55 copayment | $25 copayment | $55 copayment | $55 copayment | $55 copayment | $65 copay 1st 3 visits then ded applies | 100% coverage (ded applies) | $20 copayment | $65 copayment | $50 copayment | 60% coverage (ded applies) | $50 copayment | $30 copayment | $15 copayment | $50 copayment | $20 copayment | $10 copayment | $30 copayment | $25 copayment | $25 copayment | $15 copayment | $15 copayment |
| Specialist | 100% coverage (after deductible) | $90 copayment | $80 copay first 3 visits then deductible applies | $95 copayment first 3 visits then deductible applies | $80 copayment | $65 copayment | $80 copayment | $90 copayment | $80 copayment | $95 copay 1st 3 visits then ded applies | 100% coverage (ded applies) | $30 copayment | $95 copayment | $75 copayment | 60% coverage (ded applies) | $85 copayment | $35 copayment | $30 copayment | $85 copayment | $30 copayment | $20 copayment | $50 copayment | $50 copayment | $50 copayment | $30 copayment | $30 copayment |
| Outpatient Surgery | 100% coverage (after deductible) | 70% coverage (after ded) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | $300 copayment | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) | 60% coverage (ded applies) | 100% coverage (ded applies) | $100 copayment | 60% coverage (after deductible) | 60% coverage (ded applies) | 60% coverage (ded applies) | 70% coverage (ded applies) | $320 copayment | 70% coverage (ded applies) | 70% coverage (after deductible) | $125 copayment (per procedure) | $300 copayment (per procedure) | 70% coverage | 80% coverage | 80% coverage (ded waived) | 90% coverage | 90% coverage (ded applies) |
| Physical Therapy | 100% coverage (after deductible) | $55 copayment | $65 copayment | $65 copayment | $65 copayment | $25 copayment | $65 copayment | $55 copayment | $65 copayment | $65 copayment | 100% coverage (ded applies) | $20 copayment | $65 copayment | $50 copayment | 60% coverage | 70% coverage (ded applies) | $30 copayment | $15 copayment | $50 copayment (after deductible) | $20 copayment | $10 copayment | $30 copayment | $25 copayment | $25 copayment | $15 copayment | $15 copayment |
| Inpatient Psych | 100% coverage (after deductible) | 70% coverage (after ded) | 50% coverage (after ded) | 60% coverage (after ded) | 55% coverage (ded applies) | $600 per day 1st 5 days | 55% coverage (after ded) | 70% coverage (ded applies) | 60% coverage (after ded) | 60% coverage (ded applies) | 100% coverage (ded applies) | $250 per day 1st 5 days | 60% coverage (after deductible) | 60% coverage (ded applies) | 60% coverage (ded applies) | 70% coverage (ded applies) | $600 per day 1st 5 days | 70% coverage (ded applies) | 70% coverage (after deductible) | $250 per day 1st 5 days | $500 per admission | 70% coverage | 80% coverage (after deductible) | 80% coverage (ded applies) | 90% coverage | 90% coverage (ded applies) |
| Outpatient Psych | 100% coverage (after deductible) | $55 copayment | $60 copay first 3 visits then deductible applies | $65 copayment first 3 visits then deductible applies | $55 copayment | $25 copayment | $55 copayment | $55 copayment | $55 copayment | $95 copay 1st 3 visits then ded applies | 100% coverage (ded applies) | $15 copayment | $65 copayment | $50 copayment | 60% coverage (ded applies) | $50 copayment | $30 copayment | $15 copayment | $50 copayment | $20 copayment | $10 copayment | $30 copayment | $25 copayment | $25 copayment | $15 copayment | $15 copayment |
| Rx Tier 1 | 100% coverage (after deductible) | $17 copayment (after $300 Rxd ed) | $20 copay | $500 Rx ded then $18 ded per Rx | $20 copay | $15 copayment | $20 copay | $500 Rx ded then $17 ded per Rx | $20 copay | $18 copay after ded | 100% coverage (ded applies) | $5 copayment | $18 copay after ded | $19 copayment | $19 copay after ded | $17 copay | $15 copayment | $15 copayment | $17 copayment | $5 copayment | $5 copayment | $15 copayment | $15 copayment | $15 copayment | $10 copayment | $10 copayment |
| Rx Tier 2 | 100% coverage (after deductible) | $80 copayment (after $300 Rx ded) | 50% coverage to $500 (med ded applies) | 60% coverage to $500 (med ded applies) | $75 copay (after med ded) | $40 copayment | $75 copay (after $500 Rx ded) | $65 copay (after $300 Rx ded) | $75 copay (after $350 Rx ded) | 60% cov up to $500 per Rx after Rx ded | 100% coverage (ded applies) | $20 copayment | 60% coverage up to $500 per Rx (after $500 Rx ded) | $65 copayment (ded applies) | $80 copayment (ded applies) | $70 copayment after $300 Rx ded | $40 copayment | $40 copayment (ded applies) | $70 copayment (after $300 Rx ded) | $20 copayment | $15 copayment | $40 copayment | $50 copayment | $50 copayment | $25 copayment | $35 copayment |
| Rx Tier 3 | 100% coverage (after deductible) | $110 copayment (after $300 Rxded) | 50% coverage to $500 (med ded applies) | 60% coverage to $500 (med ded applies) | $75 copay (after med ded) | $70 copayment | $75 copay (after $500 Rx ded) | $65 copay (after $300 Rx ded) | $75 copay (after $350 Rx ded) | 60% cov up to $500 per Rx after Rx ded | 100% coverage (ded applies) | $30 copayment | 60% coverage up to $500 per Rx (after $500 Rx ded) | $100 copayment (ded applies) | $100 copayment (ded applies) | $100 copayment after $300 Rx ded | $40 copayment | $70 copayment (ded applies) | $100 copayment (after $300 Rxded) | $20 copayment | $15 copayment | $70 copayment | $80 copayment | $80 copayment | $40 copayment | $60 copayment |
| Rx Tier 4 | 100% coverage (after deductible) | 70% coverage up to $250 per Rx (after $300 Rxded) | 50% coverage to $500 (med ded applies) | 60% coverage to $500 (med ded applies) | 55% coverage to $250 (plan ded applies) | 80% coverage up to $250 per Rx | 80% cov $250 max (after $500 Rx ded) | 80% cov $250 max ben (after $300 Rx ded) | 80% cov $250 max ben (after $350 Rx ded) | 60% cov up to $500 per Rx after Rx ded | 100% coverage (ded applies) | 90% coverage (up to $250 per Rx) | 60% coverage up to $500 per Rx (after $500 Rx ded) | 60% coverage (up to $250 per Rx after ded) | 60% coverage (up to $250 per 30 day script after ded) | 70% coverage (up to $250 per Rx after $300 Rx ded) | 80% coverage to $250 max | 70% coverage (up to $250 per Rx after ded) | 70% coverage up to $250 per Rx (after $300 Rxded) | 90% cov up to $250 per Rx | 90% cov up to $250 per Rx | 70% cov ($250 max per 30 day script) | 80% coverage up to $250 per Rx | 80% coverage ($250 max per 30 day script) | 90% coverage (up to $250 per Rx) | 90% coverage (up to $250 per 30 day script) |
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| Anh Nguyen | 450.79 | 463.45 | 472.11 | 481.54 | 548.81 | 553.98 | 558.18 | 564.46 | 568.51 | 583.99 | 585.4 | 601.74 | 602.04 | 603.94 | 615.51 | 693.59 | 704.24 | 708.44 | 711.76 | 739.71 | 753.39 | 766.96 | 802.34 | 836.94 | 894.64 | 1051.88 |
| Mai Tang | 471.82 fam 1633.93 | 485.07 fam 1665.44 | 494.13 fam 1710.54 | 504.01 fam 1744.45 | 574.42 fam 1986.19 | 579.82 fam 1990.76 | 584.21 fam 2019.83 | 590.79 fam 2042.41 | 595.03 fam 2056.96 | 611.23 fam 2098.6 | 612.71 fam 2103.68 | 629.81 fam 2162.4 | 630.13 fam 2163.48 | 632.12 fam 2170.31 | 644.22 fam 2211.87 | 725.95 fam 2492.47 | 737.09 fam 2544.72 | 741.49 fam 2545.83 | 744.96 fam 2557.75 | 774.22 fam 2672.2 | 788.53 fam 2721.33 | 802.74 fam 2756.13 | 839.77 fam 2883.27 | 875.98 fam 3007.59 | 936.37 fam 3214.94 | 1100.95 fam 3780 |
| Total | 922.61 w deps 2084.72 | 948.52 w deps 2128.89 | 966.24 w deps 2182.65 | 985.55 w deps 2225.99 | 1123.23 w deps 2535.00 | 1133.80 w deps 2544.74 | 1142.39 w deps 2578.01 | 1155.25 w deps 2606.87 | 1163.54 w deps 2625.47 | 1195.22 w deps 2682.59 | 1198.11 w deps 2689.08 | 1231.55 w deps 2764.14 | 1232.17 w deps 2765.52 | 1236.06 w deps 2774.25 | 1259.73 w deps 2827.38 | 1419.54 w deps 3186.06 | 1441.33 w deps 3248.96 | 1449.93 w deps 3254.27 | 1456.72 w deps 3269.51 | 1513.93 w deps 3411.91 | 1541.92 w deps 3474.72 | 1569.70 w deps 3523.09 | 1642.11 w deps 3685.61 | 1712.92 w deps 3844.53 | 1831.01 w deps 4109.58 | 2152.83 w deps 4831.88 |